FIGURE 92.4 Transverse real-time sonogram of the pelvis of a 15-year-old patient with gonococcal salpingitis, demonstrating a 6- × 8-cm right tuboovarian abscess (A) containing a fluid–debris level U, uterus; B, bladder Finally, the emergency physician must consider the possibility of pregnancy in adolescents with presumed PID Ascending genital tract infection is rare during pregnancy As a result, alternative diagnoses to PID, including ectopic pregnancy, should be considered Hospitalization is recommended for all pregnant patients with PID Management The 2015 CDC guidelines for the treatment of PID are summarized in Table 92.3 The antibiotics listed were selected for their effectiveness in combination against N gonorrhoeae, C trachomatis, and the aerobes and anaerobes responsible for polymicrobial PID Hospitalization is recommended for any patient with PID whose diagnosis is uncertain, particularly if ectopic pregnancy or appendicitis seems likely; for patients with severe clinical illness, including those with fever or suspected pelvic abscess; and for patients who are either immunodeficient or pregnant Parenteral treatment is recommended for patients likely to fail a course